Cranial polyneuropathy--Ramsay Hunt's syndrome: case report and discussion

[S2k guideline for the diagnosis and therapy of zoster and post-zoster neuralgia]

Diese Leitlinie richtet sich an Dermatologen, Ophthalmologen, HNO-Ärzte, Pädiater, Neurologen, Virologen sowie Infektiologen, Anästhesisten und Allgemeinmediziner in Klinik und Praxis und dient zur Information für andere medizinische Fachrichtungen, die an der Behandlung des Zoster beteiligt sind. Darüber hinaus soll die Leitlinie Kostenträgern und politischen Entscheidungsträgern zur Orientierung dienen. Die Leitlinie wurde im formellen Konsensusverfahren (S2k) von Dermatologen, Virologen/Infektiologen, Ophthalmologen, HNO-Ärzten, Neurologen, Pädiatern und Anästhesisten/Schmerzmedizinern erstellt.

Die Leitlinie stellt einen Überblick über die klinische und molekulare Diagnostik sowie den Antigennachweis, die Antikörperkultur und Viruskultur dar. Diagnostisch besondere Situationen und komplizierte Verläufe der Erkrankung finden ebenfalls Berücksichtigung. Die antivirale Therapie des Zoster und der Postzosterneuralgie wird im Allgemeinen und für besondere Situationen dargelegt. Detaillierte Angaben zur Schmerzbehandlung finden Erwähnung und sind in einer Übersicht dargestellt. Ebenso werden die lokaltherapeutischen Maßnahmen thematisiert.

European consensus-based (S2k) Guideline on the Management of Herpes Zoster - guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 2: Treatment

Herpes zoster (HZ, shingles) is a frequent medical condition which may severely impact the quality of life of affected patients. Different therapeutic approaches to treat acute HZ are available. The aim of this European project was the elaboration of a consensus-based guideline on the management of patients who present with HZ, considering different patient populations and different localizations. This interdisciplinary guideline aims at an improvement of the outcomes of the acute HZ management concerning disease duration, acute pain and quality of life of the affected patients and at a reduction in the incidence of postherpetic neuralgia (PHN) and other complications. The guideline development followed a structured and pre-defined process, considering the quality criteria for guidelines development as suggested by the AGREE II instrument. The steering group was responsible for the planning and the organization of the guideline development process (Division of Evidence-Based Medicine, dEBM). The expert panel was nominated by virtue of clinical expertise and/or scientific experience and included experts from the fields of dermatology, virology/infectiology, ophthalmology, otolaryngology, neurology and anaesthesiology. Recommendations for clinical practice were formally consented during the consensus conference, explicitly considering different relevant aspects. The guideline was approved by the commissioning societies after an extensive internal and external review process. In this second part of the guideline, therapeutic interventions have been evaluated. The expert panel formally consented recommendations for the treatment of patients with HZ (antiviral medication, pain management, local therapy), considering various clinical situations. Users of the guideline must carefully check whether the recommendations are appropriate for the context of intended application. In the setting of an international guideline, it is generally important to consider different national approaches and legal circumstances with regard to the regulatory approval, availability and reimbursement of diagnostic and therapeutic interventions.

A case of ramsay hunt syndrome with cranial polyneuropathy

Ramsay Hunt syndrome is an infectious disease caused by the varicella zoster virus. It is characterized by the symptoms of facial paralysis, otalgia, and erythematous vesicular rash on the auricle and/or oral cavity. We present a case of a patient with clinical evidence of Ramsay Hunt syndrome involving the cranial nerves VI, VII, and VIII. The patient, a 66-year-old woman, showed left facial palsy associated with vesicular eruptions on her left auricle, impaired gaze to left side, and left hearing loss. Four months after the treatment with systemic steroid and antiviral agents, her all symptoms and signs including facial paralysis and diplopia disappeared.

Ramsay Hunt syndrome with multicranial nerve involvement

CONCLUSIONS

Ramsay Hunt syndrome (RHS) with multiple involvement of cranial nerves is more severe and intractable than RHS without such involvement.

OBJECTIVES

Typically, RHS involves VII and VIII nerves and unilaterally, and RHS accompanied by multiple cranial neuropathy is very rare. We describe 11 patients who developed RHS with multicranial nerve involvement and we analyzed their clinical characteristics and compared them with those of patients with RHS not accompanied by multiple cranial neuropathy.

METHODS

During the period 1995-2009, we treated 339 patients with RHS; of these, 11 patients had concurrent multiple cranial neuropathy. We assessed the clinical characteristics of RHS patients with and without multiple cranial neuropathy.

RESULTS

The mean age of the 11 patients with multiple cranial neuropathy (6 men, 5 women) was 49.2 ± 19.4 years, although 7 were aged 50 years or older. Eight patients had right-sided and three had left-sided facial paralysis. The initial degree of facial paralysis was House-Brackmann (HB) grade IV in four patients (36.4%) and HB grade V in seven (63.6%). Six patients showed improvement in symptoms, whereas five (45.6%) showed no improvement. The recovery rates from facial paralysis in patients with and without multiple cranial neuropathy were 54.5% and 82.9%, respectively, and the complete recovery rates were 27.3% and 67.7%, respectively.

Otalgia

The patient presenting with otalgia poses a diagnostic challenge for which orderly and diligent evaluation and management is needed. The etiology of otalgia can be either primary or referred, and a detailed history and physical examination with directed studies as indicated can elucidate the cause of the pain.

Vestibular-evoked myogenic potentials in two patients with Ramsay Hunt syndrome

We report on the function of the inferior vestibular nerve, as monitored by the vestibular-evoked myogenic potentials (VEMP), in two patients suffering from Ramsay Hunt syndrome. Both the patients presented canal paresis (CP) and hearing loss, but in one patient normal VEMP was recorded while the other presented vagus nerve paralysis plus no VEMP response at the highest stimulus intensity used in our institute (i.e., 105 dB nHL).